In Their Own Words: The Toll of Nurse Scheduling and Staffing Problems


From Predictive Analytics in Healthcare 2016: Optimizing Nurse Staffing in an Era of Workforce Shortages:

Nurse scheduling and staffing problems can impact quality of care, patient safety problems, staff burnout and turnover, and the bottom line. The following are responses by nurse managers, registered nurses and finance directors included in the Predictive Analytics Survey by AMN Healthcare and Avantas:

Nurse Manager Views

Q: How do scheduling and staffing problems affect the morale of your staff?

  • “When staffing is low, staff doesn’t have faith that it will ever get better. They don’t feel like anyone cares how hard they work, and I see how this impacts patient care.”
  • “Morale is affected adversely any time there are not sufficient staff to take care of patient needs.”
  • “When we are understaffed, our unit morale is very low. Chronic understaffing leads to increased call-ins, which exacerbates the situation. The ones who are left behind get tired of covering the unit.”
  • “Our staff gets tired, frustrated, feeling lack of respect and appreciation for the hard work that they do.” “When tasks are adding up, morale is low. It is important that the staff feel supported.”
  • “When tasks are adding up, morale is low. It is important that the staff feel supported.”

Registered Nurse Views

Q: How do scheduling and staffing problems affect patient care?

  • “When we are understaffed, patients do not get the quality care they deserve. Nurses rarely have time to really connect with patients on a human level, because they have so many patients, tasks, and charting.”
  • “Quality of patient care is not the best that I can do. I feel stretched too thin and unable to do my best.”
  • “Late medication administration, putting patients at risk for falls because you cannot get there in time, inability to chart until after shift because bedside tasks are so great…”
  • “There have been several times that staffing is unsafe — putting the patients at risk as well as my license.”
  • “Because of budget demands, we lose a secretary at 7 p.m. The secretary answers patient call lights when RNs are busy delivering care. So after the secretary leaves, call lights are often going off without anyone to answer them. This could have serious implications. A patient could be calling because they have chest pain, or maybe they are having difficulty breathing, or need help getting to the bathroom. A delay in care puts the patient at risk in case of myocardial infarction, death, falls, etc. There are too many more examples to describe.”
  • =“I feel like my patients are getting the short end of the stick, but I always try to give my all no matter what…”

Finance Manager Views

Q: What are the most challenging budgeting or cost management problems related to workforce?

  • “Shortage of staff creating overtime or contract labor time…”
  • “Filling openings and keeping up with rising wages…”
  • “Hiring fewer people than our vacancies, which leads to premium pay and/or agency use…”
  • “Finding adequately trained nurses for the peaks in census…”
  • “The costs of keeping up with wages, widened domestic and international recruiting net, use of incentives…”
  • “It’s very difficult to maintain budgeted productivity levels when there aren’t sufficient people to staff the shifts.”
  • “Competition for recruiting nurses, especially bachelor-prepared nurses.”
  • “Census higher than budget, and a temp nurse pool that’s not large enough to meet our needs. So we continue to recruit for full-time and pool positions.”
  • “Because of understaffing, we have inpatients diverted and OR cases cancelled.”
  • “We are always hiring and never seem to close the vacancy gap.”

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